As Indonesia’s Jaminan Kesehatan Nasional (JKN) transitions from an expansionary phase to maturity, it faces the classic iron triangle of health policy: the tension between expanding access, containing costs, and maintaining quality. While coverage rates have soared, critical questions remain regarding the equitable distribution of these benefits in a post-pandemic landscape. This study employs an Integrative Systematic Review design, synthesizing high-impact quantitative and qualitative evidence published between 2021 and 2024. Data were extracted from six primary studies utilizing large-scale national datasets (SUSENAS, IFLS) and policy reviews. The analysis moves beyond simple pooling to perform a narrative synthesis of adjusted Odds Ratios (aOR) for utilization and benefit incidence, assessing the structural determinants of effective coverage. The synthesis reveals a distinct inverse equity trade-off. While JKN ownership significantly increases the probability of inpatient utilization (aOR: 2.35), the benefits are unevenly distributed. A middle-class capture phenomenon is evident, where upper-middle-income groups experience a 41% reduction in out-of-pocket (OOP) expenditure compared to 38% for the poorest quintile. Furthermore, a quality gap persists, with non-poor populations seeing a greater reduction in unmet needs (10.4%) than the poor (7.7%), largely driven by supply-side rigidities in remote areas and administrative literacy barriers. In conclusion, JKN has successfully dismantled financial entry barriers but has not yet resolved structural inequities. The system currently functions as a regressive subsidy where the urban middle class extracts disproportionate value. Future policy must pivot from coverage expansion to supply-side equity, implementing geographic capitation differentials and targeted non-medical benefits for vulnerable populations to close the gap between legal entitlement and effective access.

Forging the Iron Triangle of Health: An Integrative Review of Operational Health Resilience for Military and Civilian Crisis Response

Assessment of thermal comfort in residential buildings in the Iron Triangle of South Australia

Public infrastructure projects in developing regions often face performance issues due to internal capacity gaps and weak management systems. This study emphasizes both the direct and mediating effects of internal factors on project outcomes, with stronger justification for using SEM-PLS and additional comparative methods. Regression-based robustness checks and PLSpredict cross-validation are incorporated to validate the results. The research investigates the mediating role of construction management in linking internal organizational factors to project performance in the Buton Islands, Southeast Sulawesi. Key elements examined include planning quality, supervisory practices, communication effectiveness, and equipment readiness, measured against cost, time, and quality outcomes. A quantitative design using Structural Equation Modeling with Partial Least Squares (SEM-PLS) was applied to data from 54 construction professionals in government and private sectors. To address statistical concerns with the small sample size and many indicators, redundant items were eliminated (loading < 0.70), and discriminant validity was tested using HTMT ratios. Findings indicate that internal organizational conditions have a moderate but significant direct effect on project performance, while this influence is substantially strengthened when mediated by effective construction management. Novelty is underscored by situating the analysis in the Buton Islands, a geographically isolated and resource-constrained region rarely studied in international literature, extending systems theory and the Iron Triangle to new environments. The strongest predictive paths involve budgeting systems, scheduling mechanisms, and quality assurance frameworks. Beyond technical dimensions, managerial practices also foster institutional trust and resilience, offering practical guidance for policymakers and practitioners.

In 2017, the United States Senate Special Committee on Aging added public health to the Alzheimer’s disease and related dementias (ADRD) policy platform by introducing the Building Our Largest Dementia Infrastructure for Alzheimer’s Act. Since then, 34 state health departments, 7 local, 2 territorial, and 1 tribal health organization have received a BOLD Program award from the Centers for Disease Control. With the support of the Alzheimer’s Association and university-based Centers of Excellence, their efforts have increased public awareness, expanded training of health-care providers, linked public health programs and health-care systems, and supported programs to reduce the risk for ADRD. In this forum, we draw on examples of federal and state policymaking targeting persons living with dementia and demonstrate how iron triangles consisting of advocacy organizations, public servants and policymakers have been critical in building a public policy platform for more than 50 years. We then consider how public health leadership may rely on such iron triangles to expand their role, focusing on the critical role assumed by professional and academic organizations in educating and training those who may help respond to the public health crisis being presented by the booming number of older Americans with ADRD.

TheJapanese co-operativelegislationis characterized by the separatelawsthat are specializing to regulate the particular categories of co-operatives andenacted in line with the industrial policies,and the strong government’s control on incorporation and business activities.The Industrial Co-operativeAct of 1900 was a uniform law following the German model and provided for the legal frameworkofcredit, supply, marketing and production1co-operatives.After the Second World War, the allied force introduced the radical land reform as a part ofeconomic democratization programsand helped to enact the Agricultural Co-operative Actin 1947 to cement the effects of reform through organizing farmers in agriculturalco-operatives. Then, the other co-operative lawswere enacted in line with industrial policies (fishery, forestry, banking, SMEsetc.) during 1948-1978. The exception was the Consumer Co-operativeAct of 1948 that placedserious impediments to co-operative activities including the complete prohibition of non-member business, the limitation of operating areas within a prefecture and the lack of credit business.As a result, there are more than 10 co-operative laws inJapanthat enable governmentstomake the strongcontrolover co-operative activitiesfor matters related to organization law as well as business laws. Such legal-administrative system based on laws and regulating ministries has resulted in the emergence of different organizational culture and politicalorientation of co-operativeswhile it contributed to the creation offragmented political economy dominated by the iron triangle of ministries, legislature and trade associations (Masahiko Aoki’s compartmentalized pluralism). It has been very convenient to ministries but might resulted in the lack ofidentityasa co-operative sector. After nearly 30 years efforts, the Workers Co-operative Act (WCA) passed the Diet on December 4th, 2020.WCA has some unique features compared to the existing laws and may give impacts to the existing co-operativelaws.This paper describes the brief history leading to the enactment ofWCA, explains the outline of WCA, discusses the potential impact to the existing co-operative lawsand concludes with some suggestions to make full use of WCA to operationalize workers co-operatives andenergize co-operative movement as a whole.

This study focuses on thermal comfort in residential buildings within the Iron Triangle area of South Australia, examining how indoor conditions influence residents’ comfort and adaptive behaviours. Conducted from June 2023 to February 2024 across 30 homes in Port Pirie, Port Augusta, and Whyalla, the research gathered data from 38 residents, who reported indoor comfort levels in living rooms and bedrooms. A total of 3540 responses were obtained. At the same time, the measurement of indoor conditions in the buildings was performed using a small HOBO MX1104 device. Using the Mean Thermal Sensation Vote (MTSV) concept, it was possible to determine the neutral operative temperature and temperature ranges for thermal comfort categories. According to the defined linear regression formula, the neutral temperature was 23.9 °C. In living rooms, it was slightly lower, at 23.7 °C, and in bedrooms, slightly higher, at 24.4 °C. For comparison, the neutral temperature was calculated based on the average Predicted Mean Vote (MPMV) and equal to 24.3 °C. Comparison of the regression curves showed that in terms of slope, the MPMV curve is steeper (slope 0.282) than the MTSV curve (slope 0.1726), and lies above it. Regarding the residents’ behaviour, a strong correlation was found between the operative temperature To and the degree of clothing Icl in living rooms. Use of ceiling fans was also studied. A clear trend was also observed regarding window and door opening. The findings of the research can be used to inform the design and operation of residential buildings with a view to enhancing thermal comfort and energy efficiency.

Global investment in Information Technology (IT) reached USD 3.11 trillion in 2022. Due to the complexity and substantial investments required in this field, techniques for the early identification of risk factors that lead to project failure have become a critical focus for organizations and the scientific community. Research indicates that 29% of IT projects are successful, 52% encounter complications during execution, and 19% are canceled. This study aimed to analyze the factors influencing the success and/or failure of IT projects. The study seeks to answer the following question: What are the factors that influence the success and/or failure of IT projects? The study employed a quantitative approach, utilizing Structural Equation Modeling, and gathered data from 130 professionals involved in IT projects. The findings revealed that the success of an IT project is not determined by a single factor but rather by a combination of interrelated variables. Defining success criteria at the project's inception was found to have a positive impact across both analytical methods employed. Moreover, traditional frameworks such as the Iron Triangle (cost, scope, and schedule), long regarded as predictors of project success, proved insufficient when considered in isolation.

A new paradigm, "healthcare's new iron triangle," has been developed to emphasise the technological perspective of healthcare delivery, focusing on automation, value and empathy. The study aims to build a conceptual model and to identify factors for the enhancement of the new iron triangle in healthcare organisations. The healthcare organisation is the primary focus point of the current study. To determine the factors, a survey of the literature and healthcare experts' opinions was conducted. Thehealthcare professionals validated the identified factors. Data for this study were gathered using a closed-ended questionnaire and scheduled interviews. The study employed "Total Interpretive Structural Modeling methodology and Matriced' Impacts Croise´s Multiplication Appliqué´ a UN Classement/Cross-Impact Matrix Multiplication Applied to a Classification (MICMAC) analysis" to address the "why" and "how" the factors interact and prioritise the identified factors. The study found that organisational structure (F8), artificial intelligence (F1), innovation (F2) and human resources (F5) are the driving or key factors of the study. The study primarily focused on identifying factors for the enhancement of a new iron triangle in healthcare organisations. The scope could eventually be expanded to explore more areas. Academics and other stakeholders will have a better understanding of the key drivers for the enhancement of the new iron triangle in healthcare organisations. In this study, total interpretive structural modeling and cross-impact MICMAC analysis are proposed as an innovative approach to address the new iron triangle in healthcare organisations.

Purpose Before selecting a contractor and commencing construction work, creating documentation that describes the facility to be built is needed. Often, this documentation contains a large number of errors and deficiencies of significance. This study analyses a model comprising four latent variables and explores how three specific constructs – communication and change management (COM), project documentation supervision (PRS), and quality of technical specifications in the tender documentation (QTS) – contribute to construction project success (SPR). Design/methodology/approach The original data were collected from experienced Czech construction implementation professionals. A survey was conducted using an online questionnaire. Partial least squares structural equation modelling was used for analysis. Findings Both advanced COM and effective and thorough PRS positively affect SPR in the context of the time-, cost-, and quality-related concepts of the Iron Triangle. The quality of the technical specifications of tender documentation serves as an important mediating variable suggesting an independent review of this documentation before it is used for contractor selection. Originality/value In contrast to prior research, this study aims to elucidate the significance of documentation quality in relation to project success during the initial phase. The delivery and subsequent approval of documentation are posited as critical milestones that influence the performance dimensions of the iron triangle, namely, scope, time, and cost. Therefore, we argue that communication and change management should be central, primarily in the pre-investment phase, to ensure ideal error-free documentation.

This study examines the one village – one product public policy process by comparing Thailand’s OTOP scheme and Japan’s OVOP scheme. The specific objectives of this study are 1) to examine the policy process on the OVOP of Japan and OTOP of Thailand and 2) to explore lessons learn for OVOP practices in Myanmar by comparing the OVOP scheme and OTOP scheme. This study conducted the comparative analysis with a backbone of the public process: problem identification, policy formulation, and policy implementation for one village, one product (OVOP), and one tampon, one product (OTOP). The three diagnosis models analyzed these three phases of the public policy process for each respective stage. Multiple streams such as the iron triangle, and top-down, bottom-up approach models exist. This study adopted documentary analysis techniques such as comparative contextual, and thematic analysis as major research methods. The system extracts the required data and information form relevant textbooks, academic articles periodical journals, and websites. The first findings of this comparative analysis indicate that the 1997 financial crisis was a significant problem for OTOP, while the economic stagnation of Oita Prefecture was a major factor in the agenda-setting of OVOP. In the policy formulation process, Thailand established OTOP by the iron triangle because Thaksin and the TRT party won the election and took the major role in coordinating the iron triangle mechanism. On one side, OVOP is advocated solely by Hiramatsu and is not aligned with an iron triangle. OTOP used the Top-down policy implementation approach, and OVOP used bottom-up approach for policy implementation. According to the result of the comparative analysis, Myanmar can learn lessons from its One village, one product scheme initiatives for forthcomings.

In the era of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity) and technological disruption, Indonesia’s construction sector faces significant challenges. This study aims to identify and evaluate the key components of human capital agility, leadership agility, and project success within this sector. Using a combination of systematic literature reviews, Focus Group Discussions (FGD), and the Fuzzy Delphi Method (FDM), this research develops and refines assessment frameworks for these variables. The findings highlight that project success extends beyond the traditional dimensions of time, cost, and quality (iron triangle) to include sustainability, environmental performance, and stakeholder satisfaction. From 20 proposed components, 17 were validated for human capital agility, emphasizing flexibility, responsiveness, and proactivity as key elements. Similarly, leadership agility is characterized by resilience, emotionally intelligent, adaptable, and responsive, with 17 validated components out of 22. Furthermore, this study identifies critical project success factors, including time, quality, profitability, health, cost and safety, with defuzzification scores exceeding 0.89. This research contributes both theoretically and practically by providing a strategic framework to enhance the competitiveness and sustainability of Indonesia’s construction sector. Stakeholders are encouraged to optimize human capital and leadership agility to effectively address dynamic project environments.

Background and Originality: The project triangle, also named as the triple constraint, iron triangle, golden triangle, and agile triangle, is a central concept in project management research and practice that represents the relationship between key performance measures. However, there is disagreement about which criteria should be represented at the vertices of this triangle. The purpose of this paper is to explore which concepts are part of the project triangle and how these concepts have changed over time. Our purpose is to conduct a systematic review of scientific articles dealing with the topic of the project triangle and its elements (time, cost and scope). We want to demonstrate that there is a theoretical gap in the classical theory of the project triangle and that the elements of the project triangle are ultimately reflected in successful project management. Addressing this topic will contribute to eliminating or at least reducing the perceived theoretical research gap, or confusion regarding the positioning of the elements of the project triangle and the connection of these elements to the success of projects. Method: A systematic review of the scientific literature will be conducted using publicly available databases, namely "iron triangle", "triple constraint”, “project performance" and "success factors" as search terms. Scientific articles and doctoral/master's theses were searched in the databases Academia.edu, ProQuest, ScienceDirect, Elsevier/Scopus and Google Scholar. We excluded literature that does not directly relate to the field of research. Results: We found out that there is a gap in the basic theory of the project triangle or to be more exact confusion about the positioning of quality and scope of the project in the project triangle. We therefore want to reduce the gap and confirm the thesis that quality is not one of the 3 elements of the project triangle, but is indirectly defined through the elements of the project triangle (time, cost, scope). The authors of the research carried out so far listed the elements of the project triangle and defined success criteria of the projects by group, among which the individual elements of the project triangle were classified. We expect to confirm the hypothesis that there is a connection between the elements of the project triangle and success of projects. Society: Our research will confirm the dimensions of the project triangle concept and show the influence of its elements on the most common groups of success criteria, with the help of which companies measure the success of projects. This research will show which elements of the project triangle and criteria are given greater importance by the scientific literature, which represents a starting point for optimization in the field of managing various types of projects. Understanding the concept of the project triangle and its role in the creation of success criteria will help the various stakeholders involved in project management to be more motivated to monitor the elements of the project triangle and that this will allow them to manage more effectively, which in turn also affects their commitment in performing project duties. Limitations / further research: The topic under discussion has been well studied for the past 20 years, although it has undergone a great deal of theoretical transformation. At the same time, we note that the theoretical treatment is not followed by scientific research, as it mainly covers the field of methodology, factors and strategies for the success of project management in the construction industry or on large investment projects, in the field of IT and healthcare. Proposals for further research will be made in order to conduct research on this topic in other industries and on other types of projects and on several different stakeholders and/or stakeholder groups involved in project management.

The construction project's success generally implies completion within the planned deadline and budget and satisfactory quality performance. These three project performance parameters form the basic system of measuring its success - the iron triangle of project management. Unfortunately, construction projects often fail to meet the defined success parameters, one or more. The focus of this paper is the territory of Croatia, for which it was noticed that no comprehensive studies analyze the construction projects' success in terms of all three iron triangle parameters. This paper aimed to observe an extensive database of projects from Croatia, analyze their success in terms of time, costs, and construction quality, and determine the mutual relations between those three parameters. Based on a database of 49 construction projects, it was determined that a significant number of projects (46.94%) were not satisfactory regarding time and cost success. At the same time, problematic quality performance was less common (20.41%). Statistically significant correlations were established between the performance of time and cost. Developing reliable mathematical models for predicting real construction time and cost is also possible. As for the construction quality, the problem of its presentation and assessment has been established, and no statistically significant results have been determined by observing it. These results indicate the need for further research, primarily regarding the project performance quality. The overall results emphasize the importance of comprehensive, systematic and timely construction project management, primarily during the planning and execution phases, to achieve its goals.

Background/Objectives: This paper brings to light the results of extensive research on the dimension of dental care in Romania in terms of priorities and policies defined at the governmental level for a 25-year period (1999-2023). This research aims to present both individual and ecosystem perspectives on the influence of the way oral health strategies are shaped in Romania. Methods: The data collected are analyzed through the prism of the "iron triangle of healthcare", focusing on the evolution of dental care from the perspective of the interrelationship of three important components: cost, quality, and access to healthcare services. Results: The paper provides insight and clarity into the context in which the doctor-patient relationship is constructed and developed, as well as a vision of how oral health policies should be designed to meet the individual needs of the patient, which will have an impact on the health and quality of life of the whole community. Conclusions: This study emphasizes the need to reconfigure oral health policies in Romania. Despite some input achievements like a considerable number of dentists, the systemic challenges that developed over these 25 years (such as insufficient funding, the reduced reimbursed procedures, and the limited dentists contracting with NHIH) have significantly contributed to a stagnation or decline of the oral health outcomes at the societal level.

Breaking the Iron Triangle in Behavioral Research with GenAI

In printed media, not only do newspapers play a key role but also its editors and, perhaps even more so, the owners of these newspapers. Those are the ones who Beecher calls media moguls. Among the handful of newspaper proprietors, Rupert Murdoch is not only the most infamous but also the most notorious. Beecher, who was once an editor for Murdoch, delivers an inside view of the internal affairs of Murdoch’s news empire. This includes not only Murdoch’s activities in the UK and Australia, but also in the USA. In the USA, for example, Fox has become a propaganda apparatus for Trump. Yet, long before Trump moved from being a sleazy TV host into politics and having received the support of Murdoch, Murdoch’s far right influence into politics were felt most sharply in Murdoch’s home country of Australia as well as the UK. Murdoch’s phone hacking, his relentless and tremendous support for UK Tories and Brexit are examples that explain the power triangle between Murdoch’s media, voters, and politics. Murdoch has created something that might best be called the Iron Triangle of Media Capitalism. How this works is explained here.Eric Beecher. 2024. The Men Who Killed the News: The Inside Story of How Media Moguls Abused their Power, Manipulated the Truth and Distorted Democracy. Melbourne: Simon & Schuster. ISBN: 9781761428043, $ 16.99 (eBook), pp. 416 (pbk.), pp. 901 (eBook), notes and index.

Green construction is considered to be a construction model that pursues high resource efficiency and the utilization of reduced environmental impacts through technological innovation and management optimization under the realization of the project’s iron triangle. The realization of its performance relies on the level of stakeholder capability configuration. To reveal the optimal capability configuration and interaction between regulators and executors, this study constructed a utility model based on a post-positivist methodology. By analyzing the optimal capability configuration and coordination levels of regulators and executors according to the practices and constraints of green construction, this study conducted a static analysis to compare the effects of marginal value on regulators’ capability input and coordination coefficients. Finally, a sensitivity analysis uncovers the changes in capability configuration interaction and coordination coefficients at different stages of green construction. The results indicate that high levels of coordination in green construction cannot be maintained in the long term; continuous capability input from regulators is required for sustained support. Only by eliminating external uncertainties, reducing the variable costs for executors in advancing green construction, and controlling their risk aversion can executors be truly motivated to promote green construction. The capability configuration of both regulators and executors adjusts with corresponding marginal values. The capability configuration of executors shows a trend of initially increasing and then decreasing as the progressive coefficient rises. The model proposed in this study ensures that the final coordination level stabilizes at a relatively high level, which is between 0.6 and 0.7. In summary, the breakthrough findings provide critical insights into green construction management, contributing to the achievement of the anticipated green construction objectives.

This study aims to understand how entrepreneurs, especially members of the Indonesian Young Entrepreneurs Association (HIPMI) Denpasar branch, prioritize and balance price, quality, and service factors in running their businesses. Using an interpretive approach and in-depth interview method, this study explores entrepreneurs' experiences and strategies in applying the Iron Triangle Concept to face market competition. The research findings show that the priority of one factor is influenced by market conditions, consumer needs, and the business's position in the growth cycle. Entrepreneurs who prioritize price tend to use competitive strategies to attract consumers, while those who prioritize quality focus on improving the reputation of products or services. On the other hand, superior service is an important factor in building long-term customer loyalty.This study confirms that business success lies in the ability to balance these three factors adaptively according to market dynamics. In addition, these findings provide practical insights for novice entrepreneurs in understanding how to manage the basic elements that are important for building business sustainability and legitimacy. This study contributes to the entrepreneurship literature by offering strategic guidance based on real experiences for entrepreneurs in managing the complexity of competitive markets.

Egypt’s economy is unstable, marked by high unemployment, low incomes, and safety concerns, which impede its rapid development. One crucial sector that faces difficulties is construction, dealing with issues like funding shortages, payment disputes, and ineffective project management. Conventional project success criteria strongly emphasize efficient resource use and waste minimization. These criteria are symbolized by the iron triangle of cost, time, and quality. A key instrument for obtaining value for money in building projects is value engineering (VE). Even though VE is acknowledged in theory, its application is still limited in most developing countries, including the Egyptian construction industry. Therefore, to bridge the gap between theory and practice, this paper attempts to investigate the current state and application of VE in Egypt. The study further outlines strategies for integrating VE into construction practices and identifies obstacles to their implementation. This study employed both qualitative and quantitative research approaches to attain the research aim, beginning with a thorough literature review to assess the application of value engineering (VE) in both local and international construction industries. Then, a web-based survey was conducted to gather diverse perspectives on VE’s role and its current practice in Egyptian construction projects. The gathered data were analyzed mainly using descriptive and thematic analysis approaches. The paper’s findings revealed that there is a large gap between VE in theory and practice in Egypt. Reasons include lack of awareness and understanding, time and financial constraints, and resistance to change. Bridging the gap to enhance VE in Egypt includes a focus on the role of educational institutions and training, public awareness and recognition, and early project lifecycle integration. This research has gained insights about VE environment, process, duration, types of projects applied, and effectiveness, aiming to get a comprehensive overview of VE in Egypt. Furthermore, this research has identified a significant gap between VE theory and practice in Egypt. To bridge this gap and enhance the implementation of VE in Egypt, strategies such as focusing on the role of educational institutions, increasing public awareness and recognition, and integrating VE approach early in the project lifecycle are suggested. These findings will guide construction industry practitioners to deeply understand the current state of VE in Egypt and practically integrate VE in the construction industry to minimize unnecessary costs, enhance functionality requirements, and achieve value for client’s money.